This practice is rated as Good overall. (Previous inspection 28 October 2014– Good overall)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those recently retired and students – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) - Good
We carried out an announced comprehensive inspection at Jubilee Medical Centre on 23 March 2018 as part of our routine inspection programme.
At this inspection we found:
- The number of patients on the practice list had increased by approximately 1,000 patients since our last inspection in 2014.The practice recognised the challenges they faced from patient needs and were in the process of reviewing and embedding their values and systems to try to meet these demands. The practice had reviewed the staff skill mix to make better use of GP time and had taken on additional staff, including a pharmacy team.
- The practice had increased the remit of the pharmacy team over the past four years to cover all medication reviews, prescription signing and dealing with medication changes identified in secondary care letters. Pharmacists also offered advice on medication optimisation following chronic disease reviews. We saw evidence from 2014-2018 of the effectiveness of this, for example, demonstrating better blood sugar control for diabetic patients
- The practice had also sought innovative ways to improve patient access to services. For example, by the use of e consult. Results from the national GP patient survey from July 2017 showed that patients’ satisfaction with the service and how they could access care and treatment was higher compared to local and national averages. Patients were able to access care and treatment from the practice on the same day that they requested it.
- There was an open and transparent approach to safety and a system in place for reporting and recording significant events. We saw evidence that the practice learnt from incidents and adapted systems to improve when necessary.
- Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, not all staff had received regular formal appraisals of their work, as there had been an increase in new staff employed and existing staff were being trained up for other roles, which took time. Although formal appraisals had not been carried out for all staff, there was evidence of informal reviews with some staff including regular review of development needs and opportunities. The practice recognised this as one of their areas for development and had plans in place.
- Care Quality Commission (CQC) comment cards and GP national patient survey data reviewed indicated that patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
- Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
- There was a clear leadership structure and staff felt supported and valued by management. The practice proactively sought feedback from staff and patients, which it acted on.
- The provider was aware of the requirements of the duty of candour.
We saw areas of outstanding practice:
- The practice recognised that they had previously had a high rate of dermatology referrals. The practice had purchased a dermatoscope and trained a GP in the use this so that other clinicians could seek timely advice in house. We saw audit results that this had reduced unnecessary dermatology referrals.
- The practice recognised that their practice population had a higher than average depression prevalence (14% compared to a national average of 9%). The practice informed us that they had initiated a local psychiatry collaborative pilot with the community mental health team which had reduced referrals to secondary care by 50%.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice